1. IAEA Quality Audits in Radiotherapy
Izewska, J; Bera, P; Azangwe, G*; Rosenblatt, E; Zubizarreta, E; Meghzifene, A
International Atomic Energy Agency, Vienna, Austria

2. IAEA audits in radiotherapy
SINCE 1969: IAEA/WHO TLD postal dose audits of radiotherapy beam calibration (>40 years of operation):
126 countries, ~1850 hospitals, >9000 beams
SINCE 1981:
TLD audits for ~70 SSDLs
SINCE 2005:
Quality Assurance
Team for Radiation
Oncology (QUATRO)
NEW: TPS audit

3. Dose audit networks for radiotherapy
Country participating in the IAEA/WHO TLD service
National QA network or participant in international network other than IAEA
QA network co-operating with IAEA
Country not having radiotherapy or not participating in an audit network

5. Follow-up of poor TLD results
The IAEA dosimetry travel kit used for QA missions to radiotherapy hospitals

6. TLD results within the 5% limit (1)

7. TLD results within the 5% limit (2)
In , 5491 beams were checked with 538 TLD results followed-up (EU ~ 47%, AM ~ 25%, WP ~ 14%)

8. TLD results for SSDLs: 2000-2011

9. Comprehensive RT audit: QUATRO

10. On-site audit procedures
Typically 5 days per RT department
Entrance briefing
Assessment: complete tour of facility, staff interviews, review & evaluation of procedures and documentation, measurements, tests of procedures, observation of practical work
Exit briefing: feedback
to the department,
preliminary
recommendations,
questions, discussion.

11. QUATRO audits: summary
Regional workshops have been organised to train auditors
So far more than 70 missions have been conducted and more are planned
Most audits have been in Europe
QUATRO Audit assessed adequacies in:
Infrastructure
Patient related procedures
Equipment related procedures
Training programmes
Staffing

12. Recommendations by QUATRO
Support staff continuous education
Strengthen QA programmes and procedures
Equipment: get more, use better
Increase staffing level: MP, RO, RTT
Better trained staff: RTT, RO, MP
Improve treatment protocols
Improve structure and organization of cancer centres

13. New IAEA procedures: TPS audit
Set of practical tests for dosimetry calculations reflecting typical treatment techniques in a radiotherapy department

14. Implementation of TPS audit
Steps in implementation of TPS audits:
IAEA multicentre pilot study
TPS test audit runs in Baltic countries and Hungary
National TPS audit exercises supported by IAEA (Europe)
TPS audit package is available from IAEA on request.

15. RESULT: QUALITY IMPROVEMENT – SAFETY FOR PATIENTS
Conclusion
The IAEA/WHO TLD audits contribute to the improvement of the status of radiotherapy dosimetry worldwide
QUATRO is a useful tool for peer reviewing radiotherapy practices; it documents weak links in hospital operations and procedures, and offers recommendations to address them.
TPS audits help the physicist appreciate limitations of treatment planning systems and the importance of independent verification of plans before treatment.
RESULT: QUALITY IMPROVEMENT – SAFETY FOR PATIENTS